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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629503
Report Date: 09/09/2024
Date Signed: 09/09/2024 06:16:03 PM

Document Has Been Signed on 09/09/2024 06:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SAID, FADUMA FAMILY CHILD CAREFACILITY NUMBER:
376629503
ADMINISTRATOR/
DIRECTOR:		FADUMA SAIDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 708-1250
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
09/09/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Faduma SaidTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On 09/09/24 at 3:30PM, Licensing Program Analyst (LPA) Luigi Gargaro conducted an unannounced case management visit to the facility to issue citations for violations for that were discovered during an 08/14/24 complaint investigation visit. During the visit that day, the licensee did not have a facility roster available for review or any records available for three attending siblings. The licensee has since provided analyst with a copy of an updated roster and today allowed him to review facility records for the mentioned children.

The licensee was cited two Type B citations for the violations during today's visit that are being cited on the attached LIC 809D. Analyst also provided her with a copy of her appeal rights as well as a Notice of Site visit that is to remain posted for 30 days
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 09/09/2024 06:16 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 09/09/2024 at 03:45 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SAID, FADUMA FAMILY CHILD CARE
FACILITY NUMBER: 376629503

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/09/2024
Section Cited
CCR
102417(g)(8)

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102417 Operation of a Family Child Care Home (g)(8) - Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement was not met as evidenced by:
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The deficiency was corrected when licensee submitted her facility roster to analyst on 08/29/24.
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Based on LPA’s record review during a previous 08/14/24 visit, licensee did not have a facility roster available for analyst to review which poses a potential health and safety risk to children in care.
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Type B
09/16/2024
Section Cited
CCR102417(g)(7)

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102417 Operation of a Family Child Care Home (g)(8) - An emergency information card shall be maintained for each child and shall include the child's full name, telephone number...

This requirement was not met as evidenced by:
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Though analyst was able to review missing files for children #2, #3 and #4 during today's visit, licensee had a child in care, child #1, who comes in on a drop in basis who is not on the facility roster and does not have a records file. Licensee states she will add the child to the roster and submit a copy of the facility records for child #1 by 09/16/24.
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Based on LPA’s record review during a previous 08/14/24 visit, licensee did not have facility files for sibling children #2, #3 and #4 and during today's visit did not have a file for child #1 who was present today which poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2024


LIC809 (FAS) - (06/04)
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